Change Needed to Fix Gender Discrimination in Emergency Medicine, Male ED Chairs Say

Despite experiencing negative emotions after witnessing gender-based discrimination against female colleagues in emergency medicine, some men serving as academic department chairs reported choosing not to intervene due to an unsupportive workplace culture, a qualitative study showed.

During semi-structured teleconference interviews with 18 male emergency medicine department chairs, participants reported feeling anger, disbelief, guilt, and shame after witnessing gender-based discrimination against their female physician colleagues, according to Maya S. Iyer, MD, MEd, of Nationwide Children’s Hospital in Columbus, Ohio, and co-authors.

While some men said they reported discrimination, provided faculty development on gender-based discrimination, or enforced “zero-tolerance” policies, others reported that they did not take action for various reasons, including believing that the incident did not warrant a response, perceiving a power differential or an unsupportive institutional culture, and self-preservation, Iyer and team noted in JAMA Network Open.

“Gender-based discrimination does not occur in a vacuum in academic medicine,” Iyer told MedPage Today. “Many times, it is observed, and witnesses do not act upon it as upstanders for numerous reasons, but often because they do not feel that their workplace culture will support them.”

“Acknowledging and understanding [gender-based discrimination], along with other unconscious biases, is the first step,” she added. “In addition, leaders should cultivate leadership development in women and minorities through initiatives to hire, retain, and promote career advancement. These are actions that can help instill a feeling of belonging.”

The participants described several different types of incidents that they considered gender-based discrimination, including sexist and derogatory comments, sexist humor, inappropriate sexual interactions, belittling of ideas or contributions, and discrimination in employment practices.

One of the participants told the researchers that “the most obvious manifestations of gender disparities [in academic medicine] is in the way people are treated and interacted with every day, you know, on the floor or in committee meetings.”

The participants also said that power structures in their workplace were a key reason for not speaking out against discrimination. In fact, one participant told the researchers that “if it’s somebody who’s got a lot of power over me, how do I engage in that situation? I hope I do the right thing as much as I can. But sometimes the power differential’s just too large.”

Other participants stated that they thought gender-based discriminatory comments were not significant enough to warrant a response, with one participant explaining that “sometimes people just say subtle things, not necessarily directed at anyone. I don’t think it’s intentional and oftentimes people are not even really paying attention, so they are unrecognized.”

This study was a secondary analysis of data from a previous study about the differences in experiences of leadership among emergency medicine department chairs based on gender, which concluded that women should be encouraged to pursue leadership through sponsorship and specific purpose-driven strategies.

Iyer and team noted that approximately 60% of women physicians in emergency medicine have experienced gender-based discrimination, mostly from patients, other physicians, and nursing staff.

The current study focused on the experiences of male emergency medicine chairs to understand their perceptions of how gender influences leadership in their departments. The overall takeaway from the report was that men in these positions believed that the culture of their institution was the primary hindrance to stopping gender-based discrimination, Iyer and colleagues said.

“Our paper suggests that the hierarchical culture of academic medicine must change to one that enables anyone to speak out against [gender-based discrimination] in such a way that they do not have to fear retaliation and feel supported,” Iyer noted.

The 18 male participants had a mean age of 52.2 years, and mean time as a department chair was 7.2 years. The interviews were conducted between April 2020 and February 2021 using Zoom.